Patient Safety and Quality

A nurse is changing the dressing of a postoperative patient. The nursing assistant informs the nurse that another patient has fallen down near the nursing station after losing consciousness. What is the best nursing action in this situation?

*Attend to the patient who lost consciousness*. Loss of consciousness may pose a threat to the patient's safety and survival, and is a high-priority need. Therefore, the nurse should attend to the unconscious patient.

Fire Safety: PASS

*P* -Pull. *A* -Aim. *S* -Squeeze. *S* -Sweep.

Fire Safety: RACE

*R*-rescue: protect/evacuate clients in danger. *A*-alarm: activate alarm/report the fire. *C*-contain: close doors/windows. *E*-Extinguish: use the correct extinguisher to. eliminate the fire

R-E-S-T-R-A-I-N-T Acronym

*R*: Respond to the present, not the past. *E*: Evaluate for potential for injury. *S*: Speak with family members or caregivers. *T*: Try alternative measures first. *R*: Reassess the client to determine success of restraint. *A*: Alert the physician and family of need of restraint. *I*: Individualize restraint use. *N*: Note important information on chart. *T*: Time limit the use of restraints.

Maslow's Hierarchy of Needs

-(level 1) Physiological Needs. -(level 2) Safety and Security. -(level 3) Relationships, Love and Affection. -(level 4) Self Esteem. -(level 5) Self Actualization.

What is a Restraint

-Any manual method or physical or mechanical device, material or equipment attached or adjacent to the patient's body that cannot be removed easily and restricts freedom of movement or normal access to one's body. (Chemical restraints are medications that may cause the patient to relax or sleep). -It is not a usual or customary part of the diagnostic treatment procedure indicated by the medical condition or symptoms and does not sever to promote the client's independent functioning.

What is Safety?

-Culture of safety. -Environment of care. -Safe patient handling. -Patient information. -Establishing a system for education, training, and maintaining competence.

Alternatives to Restraints

-Determine whether behavior pattern exists. -Assess for pain and treat appropriately. -Rule out physical causes for agitation. -Involve the patient's family members. -Reduce stimulation, noise, and light. -Check the environment for hazards and modify if necessary. -Use therapeutic touch. -Investigate discontinuing bothersome treatment devices.

Consequences of Restraint Use

-Increased agitation. -Pressure ulcers. -Muscle weakness and atrophy. -Contractures. -Incontinence. -Fear/Perception of punishment. -Injuries (Fractures, Peripheral nerve injuries, Skin lesions, DEATH).

Restraint Guidelines

-Need an order within one hour after application, renewed q24 hours. -There are no restraints PRN (Ordered or discontinued). -Either physical or chemical restraint (Patient should not have both at once). -Remove q24 hours for assessment and needs (skin integrity, range of motion [ROM], circulation, sensation, movement [CSM]).

Safety Precautions

-Patient information. -Do not get the patient OOB without knowing activity order. -Do not get anyone food, drink, ice, without clarifying order. -Safe pathway for ambulation. -Safe medication administration. -Sharp items in sharps containers. -Label all IV lines and tubes. -Call light and phone at the side of the bed. -Pay attention to any changes in patient status. -Assess quickly to get more information. -Report to RN/Instructor ASAP.

Fall Prevention

-Provide a safe environment on admission and remain consistent. -Identify fall risk (e.g., age, medication, post operative, confusion, precious medical history or repeated falls, physically and/or mentally challenged, risk of bone fractures). -Make your patient aware of the environment (e.g., items at reach, call light [call don't fall], and personal belongings).

Safety for Cognitively Impaired

Patients who are cognitively impaired (e.g., dementia, alzhiemer's) require nurses to make arrangements such as applying bed side rails to meet the safety of the patient.

Extrinsic Factors for Falling

Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear, inadequate lighting, unstable wheels, etc. The treatment of falls must be multidimensional and multidisciplinary

Intrinsic Factors for Falling

Intrinsic factors are related to cognitive function and ability, how well the person can see, how well they can walk or maintain their balance, what kind of muscle strength they exhibit, and how well they can endure physical activity.

Behaviors that typically result in restraint use

Restraints are used only when all other possibilities have been tried and failed. -Wandering -Restlessness -Pulling out tubes -Resisting care -Violence -Benefits outweigh risks